Revitalizing Rural Communities through Institutional Reform of Quasi-Markets

Welfare services such as healthcare, elderly care, and education are key to ensuring quality of life generally, and vital for rural communities across urbanizing countries. While these sectors are largely tax-financed, several countries have established quasi-markets to achieve competition through private entry to unleash entrepreneurship, efficiency, and service provision innovation. The reforms notwithstanding, productivity improvements are modest, and the situation seems particularly bad in some rural communities. We argue that quasi-markets can only live up to expectations if the local institutional framework considers sectoral and local conditions. While competition and the profit motive are necessary conditions for local quasi-market entrepreneurship and innovation, they are not sufficient but require a set of complementary institutions that are epistemic in nature. These epistemic institutions enable users to make informed choices while simultaneously incentivizing entrepreneurs to compete and innovate along the dimensions that users value. Moreover, if the catchment area includes densely populated areas, rural communities may attract users from communities where costs are higher, thus creating new comparative advantages locally. As an illustration, we analyze the Swedish quasi-market for nursing homes for the elderly.